Tory Rob Peterson and Dr. Brandie Siegfried, English
In response to growing criticism that young doctors were insensitive to patient needs, many medical schools have now turned to literary studies to expose medical students to the thought processes necessary for evaluating and appreciating what it means to be a patient. For my research project I proposed 1) to determine the specific contributions of literary study to medicine consistently cited by pioneers in the field of medical humanities and 2) to provide a thoughtful analysis of the writings of Dr. William Carlos Williams and Dr. Richard Selzer in order to detect manifestations of these specific contributions in the clinical practices of these two physicians.
Five key points were noted throughout the literature justifying the inclusion of literary study in medical school.
1) Literary accounts of illness can teach physicians important lessons about the lives of sick people. Plato wrote that “to become a true doctor, the candidate must have passed through all the illness that he wants to cure and all the accidents and circumstances that he is to diagnose”1. Since this is impossible in today’s medicine, literary accounts of illness can be used to widen physician-readers’ knowledge of the concrete realities of being sick, in pain, terrified, or dying and enable these readers to appreciate the own unique situations of their patients.
2) Literary activities help physicians to develop and strengthen their narrative skills which in turn aid physicians in arriving at accurate diagnoses. Much of the physician’s day is spent in telling or listening to narratives of illness. To make sense of clinical information, physicians rely on skills that belong to the narrative sphere of knowledge. As Hunter put it, “The doctor stands in the same relationship to the patient as the literary critic to the poem. The task is the same: to read and interpret the signs, whether they are words or physical findings”2. Experience in the analysis of narrative can prepare physicians to stimulate patient’s narrative flow and to integrate the various signs of the patient into a meaningful whole.
3) Literature increases the physician’s knowledge of self. In an age of medicine in which many physicians feel “intellectually unrewarded” and unable to live up to their own professional goals and ideals, literary representations of the physician’s work clarify the many roles and expectations of medicine. It allows physicians and student to examine what they do in medicine and can serve to remind them of the generous goals of service and dedication for which they entered the medical profession.
4) Literary study compels doctors to respect the power of words. In medicine, language is the instrument of diagnosis and therapy, the vehicle through which the patient’s needs are expressed and the doctor’s advice conveyed. The study of literature can foster in physicians an appreciation for the ability of words to comfort, relieve, and even cure. Understanding the nuances of language, its cultural and ethnic variations and its symbolic content are as essential as any skills the clinician may possess.
5) Literary study contributes to physicians’ ability to perform acts of ethical discernment. Ethical moments occur in medicine in emergency rooms, neonatal intensive care units, heart transplant suites, and in the ordinary, everyday events of primary care medical practices. A simple analytic approach to these moral dilemmas reduces human conflicts to rational problems to be solved. The narrative approach to ethics places moral questions within the framework of a patient’s culture and biography. It allows physicians to better appreciate the conflicts, tragedy, humor, irony and ambiguity that contribute to each human life so that informed, meaningful decisions can be made about the ethical treatment of each patient.
By stating these contributions of literary study to clinical medicine I in no way intend for them to be taken as absolutes. One of the peculiar aspects of my project is the inability to prove or disprove the idea that medical students and physicians experienced in literary study are better prepared at the human side of medical care. Another is my inexperience in the clinical practice of medicine. Having only worked as an orderly in an eye surgery center and volunteered in an emergency room, I was unprepared to lend to my topic the kind of support that real-life experience can add.
In an attempt to address these problems I turned to the lives and writings of Dr. William Carlos Williams and Dr. Richard Selzer. I had hoped to use the medical practices and writings of these two physician-writers as a kind of laboratory for the justification of my hypothesis. I thought if I could just follow Dr. Williams around in his poems, autobiography, and stories as he attended to the sick in Rutherford, New Jersey and if I could be alongside Dr. Selzer in his essays as he mused over patients and experiences he encountered as a surgeon in a New Haven hospital — perhaps then I would be able to detect those ways in which an appreciation for the literary contributed to the clinical practice of these two physicians. And while I haven’t completely finished this aspect of my research and have yet to discover any conclusive findings, what I have noticed is worth sharing.
The encounters with sick patients in the writings of William Carlos Williams and Richard Selzer share a unique characteristic. Both writers voice the response to the patient not as a disease but as an ill person with a disease entwined with a personal, emotional life. In Selzer’s essay “Rounds” in which he details his impressions while visiting surgical patients, the malady is always related to the person and the person to the malady. And Williams told a medical student, “The doctor … has to come to terms with not only a disease, but a particular person: this patient, not patienthood, not lungs in general, or kidneys or hearts in general, but one guy, one gal, one kid who has some trouble, and is handling it in a way that may be different than anyone else’s way.”
In a similar fashion, both Williams and Selzer share the ability to see the unique situation of each patient and to adopt, even if momentarily, the patient’s point of view. In “The Doctor Stories” Williams wrote, “adopting the patient’s condition as one’s own to be struggled with toward a solution … I actually became them … so that when I detached myself from them … it was as though I were reawakening from a sleep.” In Selzer’s writing, one example of this is found in “Witness” in which upon wheeling the young mentally and physically impaired son of a concerned father back into the operating room for emergency surgery, Selzer writes, “I think of the immensity of love and I see for a moment what the father must see — the soul that lay in the body of the child like a chest of jewels in a sunken ship.”
My findings on the contributions of literary study to medicine have not been earth-shattering. I haven’t conclusively proven anything. But I have enjoyed adding my weight to the claim that literary study can help physicians in comprehending their patients’ suffering so that they can accompany patients through illness with respect, empathy, and effective care. I’ve enjoyed reading William Carlos Williams and Richard Selzer. I’ve enjoyed meeting with a group of University of Utah medical students and doctors who meet monthly to read and discuss literary texts. And I’ve enjoyed being reminded of why I chose English as a major and medicine as a profession. The two are connected. As Edmund Pellegrino wrote, “Medicine is the most humane of sciences, the most empiric of arts, and the most scientific of humanities”3.
1. Epstein J. “Historiography, diagnosis, and poetics.” in Literature and Medicine. (1992)11:30.
2. Hunter, K.M. “Literature and medicine: standards for applied literature.” in Applying the Humanities. Plenum Press, New York (1985)301.
3. Pellegrino, E.D. Humanism and the Physician. U of Tenn Press, Knoxville (I 979)17.